Difficult to diagnose and tricky to treat, neuropathic pain is often as puzzling as it is painful. Take this quiz to see how much you know about what neuropathy is and how to treat it.
"Neuropathy" is an umbrella term that covers a number of conditions affecting the nerves. Merriam-Webster defines neuropathy as "an abnormal and usually degenerative state of the nervous system or nerves."
Most commonly, neuropathy feels like what?
Neuropathy presents in many different ways, but most commonly, patients will complain of a persistent burning\stinging sensation in their hands or feet. Doctors call this a typical "stocking/glove" presentation.
Thirty percent of neuropathies are caused by ________________.
Twenty to thirty percent of diabetics will develop some type of neuropathy.
In addition to diabetes, other causes of neuropathies include:
Neuropathy can also result from vitamin-B deficiencies, tumors, infections, cancer treatments and certain hereditary disorders.
In most cases, addressing the _____________________ will improve or relieve neuropathic pain.
The best way to treat neuropathic pain is by treating the underlying cause of the pain.
In almost 30 percent of neuropathic pain cases, the underlying cause of the pain is ____________________.
Doctors can't always determine the underlying cause of neuropathic pain. In these cases, and in situations where treatment of the underlying cause doesn't relieve the pain, it's necessary to treat the symptoms.
_____________ are one of the first lines of defense in treating neuropathic pain.
No one knows why, but patients with chronic pain often have low levels of serotonin and other neurotransmitters. Using antidepressants will increase these levels.
Another first-line treatment for neuropathic pain involves the use of ___________________.
Anticonvulsants involving calcium channel alpha-2-delta ligands are another first-line treatment for neuropathy.
One class of antidepressants doctors often prescribe for neuropathic pain is what?
Tricyclics like Elavil (Amitriptyline) are often prescribed as a first-line treatment for neuropathy pain.
What's another class of antidepressants employed to treat neuropathic pain?
SNRIs (serotonin-norepinephrine reuptake inhibitors) like Cymbalta (Duloxetine) and Effexor (Venlafaxine) have been shown to be effective in treating neuropathic pain.
What type of anticonvulsants are often prescribed to treat neuropathic pain?
Calcium channel alpha-2-delta ligands such as Gabapentin and Pregabalin are considered to be first-line treatments for neuropathy pain.
In addition to oral medication, ______________________ can also be used to treat neuropathic pain.
Even though anticonvulsants and antidepressants are effective in treating neuropathic pain, about half of those who take them will not see any improvement. In these cases, topical pain relievers might help.
One of the most common forms of topical pain relief prescribed for neuropathy pain is ______________________.
Lidocaine has been around since the 1940s. Typically, it's prescribed in 5 percent patches; up to three patches can be applied topically on a localized painful area and worn for 24 hours.
Lidocaine works by blocking which channels?
An increasing body of evidence supports the role of voltage-gated sodium channels in peripheral nerve pain and helps explain why blocking these channels helps to relieve neuropathic pain.
Another topical treatment for neuropathy is ___________________.
In one study, 33 percent of patients reported a 50 percent reduction in pain; 50 percent reported at least a 30 percent reduction after using a single high-dose capasicin patch.
Capsaicin is derived from ____________.
The active ingredient in capsaicin is derived from chili peppers. Capsaicin patches and creams are widely available over the counter for the deep-heating treatment of minor muscle pain. The dosages required for the treatment of chronic neuropathic pain, however, are much higher and require a prescription.
Medical marijuana can be used to treat neuropathic pain.
The reported benefits of Cannabinoids, of which THC(the main psychoactive compound in cannabis or marijuana) is one, have been confirmed in multiple randomized trials. A recent review concluded that 15 out of 18 trials showed that cannabinoids provided a significant pain-relieving effect when compared with a placebo.
___________________ are often considered a second-line treatment for neuropathic pain.
There's no doubt that opiates will reduce almost any kind of pain, including neuropathic. However, opiates are addictive and there are pros and cons to using them for long-term pain management.
What kind of opiates are preferred when treating neuropathic pain?
In cases where first-line treatments are ineffective, scheduled long-acting opioids like fentanyl patches or extended-release oxycodone are preferred over shorter acting agents.
Alternative and non-western modalities do not work in the treatment of neuropathic pain.
Alternative therapies like acupuncture have been shown to be effective in the treatment of neuropathic pain. In one study, acupuncture was shown to be more effective than medication in treating neuropathy induced by chemotherapy drugs.
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